Figure 1.

Classification of lipedema by evolutionary stages [21]. Stage 1: normal skin with an enlarged hypodermis; Stage 2: unevenness of the skin texture with pleats of fat and large piles of tissue growing like unencapsulated masses; Stage 3: hardening and thickening of the subcutaneous with large nodules and protrusion of cushions/accumulations of fat, especially in the thighs and around the knees; Stage 4: lipedema with lymphedema, so-called lipolymphedema.